CITY OF SOUTH LAKE TAHOE APPLICATION FOR ENCROACHMENT, EXCAVATION and GRADING WITHIN THE CITY RIGHT OF WAY

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1 CITY OF SOUTH LAKE TAHOE APPLICATION FOR ENCROACHMENT, EXCAVATION and GRADING WITHIN THE CITY RIGHT OF WAY The Right-of-Way Encroachment, Excavation & Grading Permit issued by the Public Works Department must be present at the job site at all times during construction and encroachment in the public right-of-way. The Right of Way Encroachment, Excavation & Grading Permit issued by the Public Works Department does not constitute approval by any other agency or give right to encroach, excavate or grade any portion of private property adjacent the permitted area. Work continuing beyond the ROW boundary and onto private property may require a separate grading permit to be issued (see 36-6 of City Code). The following must be submitted and approved by the Public Works Department prior to commencing work within the City Right of Way: A City Encroachment, Excavation & Grading Application, complete and signed with fees submitted A Traffic Control Plan A Temporary Best Management Plan (temporary erosion control) Drawings/diagram of the work to be performed including but not limited to: o Dimensions of roadway excavation o Restoration details o Distances from Intersections o Locations of existing Utilities Evidence of a $1,000,000 liability insurance certificate indemnifying the City which shall be maintained in forces by the permittee/contractor through the life of the project. Evidence of City Business license certificate for all parties performing work. Off-site impacts of erosion and sedimentation from a construction site are prohibited and polluting substances such as construction materials and wastes shall be contained on the site where they cannot drain or be transported into a body of water, stream channel, water conveyance structure or storm drain. A Best Management Practices (BMP's) Plan shall be implemented for all construction sites. All BMP's shall be in place or be capable of being placed within twenty-four (24) hours and must be in place prior to onset of precipitation events that can create run off at the site. The City of South Lake Tahoe maintains the right to inspect any construction site or site of encroachment. If an Inspector determines the installed storm water controls are placing the city at risk of violating its NPDES permit, the Inspector may order changes to the storm water controls. If the change is not immediately implemented, enforcement action may be taken. The Right-of-Way Encroachment, Excavation & Grading Permit issued shall adhere to the requirements of South Lake Tahoe City Code 36-6 Grading Permit Required if applicable

2 Right-of-Way Encroachment, Excavation & Grading Permit Application Property owners: Date: Property Owners Mailing Address: Phone: Agent/Contractor Name: Telephone: Agent/Contractor's Address: Agent/Contractor s Contractor's License No. Expiration Date: Current City of South Lake Tahoe Business License No. Expiration Date: Project Address: APN: Nearest Cross Street: Date project is expected to begin: Description of Project (Utility line repair, BMP implementation, etc.): Estimated quantities of soil movement or excavation: If grading or landscaping, estimate (in square feet) to be cleared: Encroachment, Excavation, & Grading Permit Questionnaire YES NO Have you provided a diagram and/or drawing of proposed work submitted with this application? Is your evidence of Liability Insurance submitted with the application? Does the Certificate Indemnify the City? Have you submitted a Traffic Control Plan with this application? Have you submitted Temporary BMP Plan with this application? Is the encroachment or excavation an emergency? (An encroachment & excavation permit must be acquired from the City Public Works Department within 24 hours after the encroachment or excavation is performed with an explanation and description of what work was performed. Failure to complete the Right-of-Way Encroachment &

3 Excavation Application will be treated the same as working without an application for Right of-way Encroachment & Excavation). YES NO (Cont d) Will your excavation be greater than 5 in depth as measured from the adjacent pavement surface? If so, have you submitted a shoring and safety plan? Is your proposed work adjacent to a stream channel, water conveyance system, flood plain or Stream Environment Zone? Is the excavation proposed greater than 250 feet in length? Will the grading or excavation create unstable, erodable slopes or spoils staging? Will the work involved or be located near drainage catch basins or drainage inlets? Has USA been contacted to mark underground utilities? The following supplemental conditions shall be part of the approved permit for encroachment, excavation & grading within the City Right of Way: 1. No grading or other land disturbance shall be performed pursuant to the permit between October 15 and May 1 without Tahoe Regional Planning Agency (TRPA) written approval. 2. All conditions of the City Code 26 Article II and 36 shall be met. Technical specifications shall meet current City design standards. 3. Permittee shall not change or modify traffic signal operation in anyway without the consent of the City and/or Caltrans. Traffic signal detection loop identification and marking are the responsibility of the Permittee/Contractor. The Permittee/Contractor shall provide the City with 48 hour notice prior to modifying traffic signal operations. 4. During performance of the work, the permittee/contractor shall provide and maintain fences, barricades, warning and directional signs, flares, and flag person(s) as required by the State of California Traffic Manual or the City Engineer, to ensure full and complete safety to the general public and workers. The permittee/contractor shall provide flag person(s) for any encroachment which results in less than one through lane in each direction of traffic flow. 5. Permittee shall not allow excavated material shall be stockpiled in a manner which will interfere with traffic or present a hazard to the public, workers or environment. Excavated material not suitable for backfill shall be removed and deposited in a location approved by the City Engineer or his representative. The street flow line shall be restored to its original shape and approved by the City Engineer or his representative. 6. Roadway Trench and Restoration requirements are as follows:

4 Project shall require full travel lane paving in accordance with the City Public Improvement and Engineering Standards Detail SD60-3 for all linear trenches located within the R/W greater than 250 in length if open trenching is utilized. All excavations shall be T-trench type in accordance with the City Public Improvements and Engineering Standards Detail SD60-1, SD60-2 and SD60-3. All excavations outside of the paved travel way shall be per Public Improvements and Engineering Standard Detail SD60-2. Excavations occurring in roadways that have been re-paved by the City in the last 5 years. Permittee shall apply a crack seal at the new/existing patch and a fog seal for a minimum of 2 greater than the cut on all sides: 7. No open trenches or pits to remain open overnight without safety fencing or traffic plate plan approved by the Public Works Department. When steel trench plating is used, the pavement shall be cold planed to a depth equal to the thickness of the plate and to a width and length equal to dimensions of the plate. Steel trench plating shall meet Caltrans Standard Method 2. The Contractor shall be responsible for maintenance of the steel plates, shoring, fencing, signage, barriers, existing pavement, and any other work required or necessary. 8. The City Engineer or his representative may cause backfilling to be inspected to determine if all material is properly placed and compacted. Backfill not conforming to the standards of compaction specified above shall be removed and recompacted by the contractor. 9. All signage removed for work or damaged by work shall be replaced to current City standards at no cost to the City. 10. Permittee/Contractor shall be responsible, at all times, to maintain temporary asphalt patch until hot mix asphalt is available. 11. Any curb determined to be undermined by the work or removed for the work associated with the project shall be replaced per City curb standards. New curb shall be dowelled to existing curb with (2) # 5 dowels each side with expansion joint. 12. Permittee/Contractor will provide access to all driveways and properties during course of work. If trench plates are to be used, plating shall meet Caltrans Method 2. The Permittee shall be responsible for maintaining safe, level, and structurally sound road and pedestrian travel ways at all times. 13. Per section (3.10) Completion of Work of the City of South Lake Tahoe Public Improvement and Engineering Standards All Permanent paving work shall be completed within twenty (20) working days of the backfill of the excavation or repair. 14. Permittee shall be responsible for installing roadway striping to all areas disturbed by the project to current City standards 15. In the event that public or private improvements are damaged or the street flow line is disturbed, restoration will be made as directed by the City Engineer or his representative. 16. To prevent damage to underground utilities and injury to workers, call USA at (800) prior to excavation. Prior to paving, call (530) to schedule inspection.

5 17. All operations will be in accordance with applicable city, state, federal and TRPA ordinances and laws pertaining thereto. The work shall proceed with due diligence and failure to comply may be cause for revocation of permit and forfeiture of all fees and deposits. 18. All permits expire on October 15 th of the year they were issued unless an extension is granted by the City Engineer. Extension requests must be submitted to the City in writing and approved by the City Engineer. ACKNOWLEDGEMENT OF CITY CODE: Applicant has reviewed all aspects of the South Lake Tahoe City Code which may be applicable to the project. By my signature which is placed below, I certify, under penalty of perjury under the laws of the State of California, that I have reviewed the South Lake Tahoe City Code, and that I will comply with all aspects of the South Lake Tahoe City Code as it may be applicable to this project. Permit Fees and Approval Fees: Encroachment - $ Grading: 3-7 Cubic Yards $ Cubic Yards $ Cubic Yards $2,003 Permit No. Public Works Department Approval City of South Lake Tahoe Approval Signature of Owner/Contractor Print Name Print Name of Owner/Contractor Inspections for excavation backfill and paving will require a twenty four (24) hour prior notice (530) THE ATTACHED DIAGRAM AND CITY STANDARD DETAILS ARE MADE PART OF THIS EXECUTED PERMIT

6 TYPE OF WORK: PLEASE INCLUDE DIMENSIONS OF CUT AND LOCATION WITHIN ROADWAY (Be Specific) Applicant s Diagram (or attach plot plan) J:\DATA-E-F\Engineering Department\Permits